The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy

Schwarze, Martin; Block, Julia; Kunz, Timothy S.; Alimusaj, Merkur; Heitzmann, Daniel; Putz, Cornelia; Dreher, Thomas; Wolf, Sebastian I.

doi:10.1016/j.gaitpost.2019.01.006

Cited by 15 publications

(24 citation statements)

References 34 publications

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“…The second factor comprehends the performance of the actuation system in aspects such as response time to position set-points, processor speed for running the detection algorithm, and the manual calibration stage that recorded the maximum flexo-extension angles of the user. On the other part, multiple studies have presented GDI analysis for children with cerebral palsy using a passive orthotic device [37,38,39]. However, in studies that involve patients with stroke using AAFO, this index was not shown.…”

Section: Discussionmentioning

confidence: 99%

Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

Gomez-Vargas

Ballén-Moreno

Barria³

et al. 2020

Preprint

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Abstract Background: Robotic devices can provide physical assistance to people who have suffered neurological impairments such as stroke. Neurological disorders related to this condition induce abnormal gait patterns, which harm the independence to execute different Activities of Daily Living (ADL). From the fundamental role of the ankle in walking, Active Ankle-Foot Orthoses (AAFOs) have been developed to enhance the users' gait patterns, and hence, their quality of life.Methods: Ten patients who suffered stroke used the actuation system of the T-FLEX orthosis triggered by an inertial sensor on the foot tip. The VICON motion capture system recorded the users' kinematics for unassisted and assisted gait modalities. Biomechanical analysis and usability assessment measured the performance of the system actuation for the participants in overground walking. Results: The biomechanical assessment exhibited changes in the range of motion of the lower joints for $70\%$ of the subjects. Moreover, the ankle kinematics showed a correlation with the variation of other movements analyzed. This variation had positive effects on 70\% of the participants in at least one joint. The Gait Deviation Index (GDI) presented significant changes for 30\% of the paretic limbs, where one volunteer increased this index in 14\%. The spatiotemporal parameters did not show significant variations between modalities, although users' cadence had a decrease. Lastly, the satisfaction with the device was positive, being the comfort the most users-selected aspect.Conclusions: This article presented the assessment of the T-FLEX actuation system in people who suffered stroke. Biomechanical results showed improvement in the ankle kinematic and variation in the other joints. In general terms, GDI did not exhibit significant changes, and Movement Analysis Profile (MAP) registered the main movements altered by the device. Future works should focus on assessing the full T-FLEX orthosis in a larger sample of patients that includes a stage of training.Trial registration: This study was registered as Preliminary Biomechanical and Usability Study of an Active Ankle-Foot Orthosis for Stroke Survivors on 30 January 2020 in Clinical Trials with the identi er No NCT04249349 (available at https://clinicaltrials.gov/ct2/show/NCT04249349).

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Section: Discussionmentioning

confidence: 99%

Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

Gomez-Vargas

Ballén-Moreno

Barria³

et al. 2020

Preprint

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“…The following orthotic designs were used:DAFO (Figures 1(a) and 1(b)), known as Nancy Hylton orthosis [9, 25]: orthosis made of thin, flexible thermoplastic polypropylene surrounding the foot up to the ankle joint. Despite a lack of scientific evidence of the latter mentioned effect, the special, custom-made footplate supports the dynamic arches of the foot and is intended to introduce proprioceptive stimuli on a reflex-based level to achieve a detonating effect [26, 27].…”

Section: Methodsmentioning

confidence: 99%

“…All study participants were equipped with a DAFO. Depending on the individual needs (gait disorder, foot deformity, height, and body mass), one of the following modular shank supplies (MSS) was additionally used in a modular orthotic design (DAFO + DESA or DAFO + GRAFO).Dynamic elastic shank adaptation (DESA, Figure 1(a)) [9]: orthosis with anterior tibial attachment (ToeOff, Allard USA Inc., USA). This off-the-shelf orthosis consists of a thin carbon fibre foot plate, which is inserted into the footwear and is connected via a spiral lateral-side carbon fibre composite lamella with the anterior shin system.…”

Section: Methodsmentioning

confidence: 99%

“…Conclusively, positive changes in the gait indices Gillette Gait Index, Gait Profile Score, and Gait Deviation Index were described [5–8]. Additional positive effects after multilevel surgery have been reported recently [9]. Unfortunately, according to the last ISPO Cerebral Palsy Consensus Conference, the study results are partly contradictory and lacking long-term studies [10, 11].…”

Section: Introductionmentioning

confidence: 99%

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Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Schwarze

Horoba

Block

et al. 2019

Rehabilitation Research and Practice

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Objective. To date there is only limited knowledge about the wearing time of orthoses. Ankle-foot orthoses (AFOs) have not been studied with this research question. Additional influences of the orthotic design as well as weekdays and the weekend are also unknown. Design. Monocentric, clinically prospective intervention study. Patients. Inclusion of 10 patients with bilateral spastic cerebral palsy. Methods. Equipment of all subjects with a dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS, dynamic elastic shank adaptation or ground reaction AFO). Integration of temperature sensors for recording the wearing time for a period of 3 months. Results. The actual wearing time was below the recommendations on actually worn days as well as the average of the entire study period. In addition, the actual usage in terms of days and hours was well below the recommendations. The wearing time showed differences between weekdays and weekend. Differences between DAFO and MSS were not detectable. Conclusion. The actual usage behavior of ankle-foot orthoses differs from the recommendations of the prescriber. This applies to both DAFOs and modular use with shank supplies. Environmental factors may have a significant impact on wearing times on weekdays and the weekend.

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“…Orthoses supply the appropriate and symmetrical biomechanical alignment to allow gait training and support functional carry-over outside periods of targeted motor training conducted by the physical therapist. 112 Apart from the expected positive effects of standing on bone mineral density and circulation, positioning in a standing table provides an elongated position of the hip and knee flexors. [113][114][115] Benefits are achieved provided that the child is positioned correctly with sufficient attention to the position of the feet, sufficient knee-and hip extension, slight abduction, and external rotation in the hips and adequate pelvic tilt.…”

Section: Positioning In Orthoses and Mobility Aidsmentioning

confidence: 99%

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy

et al. 2019

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The aim of this paper is to provide a clinically applicable overview of different tone reducing modalities and how these can interact with or augment concurrent physical therapy (PT). Botulinum toxin (BoNT), oral tone-regulating medication, intrathecal baclofen (ITB), and selective dorsal rhizotomy are discussed within a physiotherapeutic context and in view of current scientific evidence. We propose clinical reasoning strategies to identify treatment goals as well as the appropriate and corresponding treatment interventions. Instrumented measurement of spasticity, standardized clinical assessment, and 3D clinical motion analysis are scientifically sound tools to help select the appropriate treatment and, when needed, to selectively target or spare individual muscles. In addition, particular attention is given to strength training as a necessary tool to tackle muscle weakness associated with specific modalities of tone reduction. More research is needed to methodologically assess the long-term effectiveness of such individualized tone treatment, optimize parameters such as medication dosage, and gain more insight into the kind of PT techniques that are essential in conjunction with tone reduction.

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The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy

Cited by 15 publications

References 34 publications

Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

Actuation system of the ankle exoskeleton T-FLEX: first use experimental validation in people with stroke

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy

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